Evaluation of diagnostic methods for the detection of intestinal schistosomiasis in endemic areas with low parasite loads: Saline gradient, Helmintex, Kato-Katz and rapid urine test.

BACKGROUND: In some tropical countries, such as Brazil, schistosomiasis control programs have led to a significant reduction in the prevalence and parasite burden of endemic populations. In this setting, the Kato-Katz technique, as the standard diagnostic method for the diagnosis of Schistosoma mansoni infections, which involves the analysis of two slides from one fecal sample, loses its sensitivity. As a result, a significant number of infected individuals are not detected. The objective of this study was to perform extensive parasitological testing of up to three fecal samples and include a rapid urine test (POC-CCA) in a moderate prevalence area in Northern Minas Gerais, Brazil, and evaluate the performance of each test separately and in combination. METHODS AND FINDINGS: A total of 254 individuals were examined with variants of the standard Kato-Katz technique (up to18 Kato-Katz slides prepared from three fecal samples), a modified Helmintex (30 g of feces), the saline gradient (500 mg of feces), and the POC-CCA methods. We established a reference standard taking into consideration all the positive results in any of the parasitological exams. Evaluation of the parasite burden by two Kato-Katz slides confirmed that most of the individuals harbored a light infection. When additional slides and different parasitological methods were included, the estimated prevalence rose 2.3 times, from 20.4% to 45.9%. The best sensitivity was obtained with the Helmintex method (84%). All parasitological methods readily detected a high or moderate intensity of infection; however, all lost their high sensitivity in the case of low or very low intensity infections. The overall sensitivity of POC-CCA (64.9%) was similar to the six Kato-Katz slides from three fecal samples. However, POC-CCA showed low concordance (κ = 0.34) when compared with the reference standard. CONCLUSIONS: The recommended Kato-Katz method largely underestimated the prevalence of S. mansoni infection. Because the best performance was achieved with a modified Helmintex method, this technique might serve as a more precise reference standard. An extended number of Kato-Katz slides in combination with other parasitological methods or with POC-CCA was able to detect more than 80% of egg-positive individuals; however, the rapid urine test (POC-CCA) produced a considerable percentage of false positive results.

Acompanhamento terapêutico em hospital de reabilitação fisioterápica / Therapeutic monitoring in rehabilitation physiotherapy hospital

Este artigo pretende mostrar como ocorre o acompanhamento terapêutico, as dificuldades encontradas e o cruzamento entre prática e teoria, a partir da experiência com um paciente fisioterápico. No texto discutiremos um pouco sobre transferência, contratransferência, cinco estágios sobre a morte e o morrer que foram cunhados por Kübler-Ross, e verificados no contexto hospitalar em pacientes fisioterápicos. Pensaremos os significados criados pela paciente a respeito da sua vida e corpo, a partir de uma visão antropológica de sua história. O nosso relato será embasado e correlacionado às experiências de vida que levaram a paciente à angustia atual.

This article intends to show what happens in a therapeutic nursing practice, expliciting the difficulties and the connections between practice and theory. Through the experience of nursing a patient, we are going to explain what can be considered nursing. In this text we are going to discuss about transference and countertransference during psychotherapy, five stages about the death, and to die considering Kübler-Ross's works, and verify them in a rehabilitation hospital's context. We are going to regard the patient's thoughts and how she deals with her life and her own body, concerned about her background. Our study is based and related to the patient's experiences that leads him to his state now.